Healthcare Provider Details

I. General information

NPI: 1306756184
Provider Name (Legal Business Name): EMILY SHULTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NE PROFESSIONAL CT
BEND OR
97701-6063
US

IV. Provider business mailing address

62863 PEARL LN
BEND OR
97701-9568
US

V. Phone/Fax

Practice location:
  • Phone: 541-389-6313
  • Fax:
Mailing address:
  • Phone: 541-728-8959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201808972RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: